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Search for: rheumatoid arthritis    methotrexate    autoimmune disease    biomarker    gene expression    GWAS    HLA genes    non-HLA genes   

ID PMID Title PublicationDate abstract
11518181 Breastfeeding-related onset, flare, and relapse of rheumatoid arthritis. 2001 Aug The beneficial effects of pregnancy on rheumatoid arthritis have been known for decades. Only recently, however, have lactation and prolactin been targeted as predictors of onset, flare, or relapse of arthritis. Among genetically susceptible women, breastfeeding is associated with an increased risk of rheumatoid arthritis, particularly after the first pregnancy. Dietary interventions may reduce symptoms experienced by arthritic women.
10627718 Total knee arthroplasty in patients with rheumatoid arthritis. An overview. 1999 Sep Total knee arthroplasty in patients with rheumatoid arthritis presents several unique challenges. Patients with rheumatoid arthritis often have additional medical, anesthetic, and global musculoskeletal problems that are not present in the patient with osteoarthritis. In terms of the knee, these patients usually have osteopenia and may present with an array of bone and soft tissue deformities, each of which can impact the initial success and long term durability of a total knee replacement. Despite these potential difficulties, the early and long term results of total knee arthroplasty in patients with rheumatoid arthritis have proven to be excellent.
9213379 Group education for rheumatoid arthritis patients. 1997 Jun This article reviews the effectiveness of group education programs in improving the knowledge, behavior, and health status of patients with rheumatoid arthritis (RA) and evaluates to what extent various programs fulfill certain criteria for educational self-management programs. Thirty-one studies are reviewed: in 12, patients with various rheumatic diseases including RA were included, and in 19, only RA patients were studied. Group education increased the knowledge of the participants, which was maintained over long intervals. Beneficial behavioral effects were found in mixed populations but less often found in RA patients. Group education often improved physical health status both in mixed and in RA populations, but seldom led to improved psychosocial health status. In general, the beneficial effects of group education were found more often in mixed populations than in strictly RA patients. Further investigations must examine which mechanisms make educational interventions effective and determine the types of interventions or combinations of interventions that are effective. Effects of group education on health status are almost never maintained over long intervals. More research is needed to develop strategies for maintaining and enhancing early gains from group education.
9092034 [Bronchiectasis and rheumatoid arthritis. Incidence and etiopathogenic aspects. Review of 1997 Many pleural and pulmonary manifestations are described in rheumatoid arthritis, due to the disease itself or drug-induced. A literature review revealed 289 reports of bronchiectasis since 1928, the respiratory symptoms preceding the articular features in 90%. Although the frequency of bronchiectasis in the general population is difficult to assess, and thus maybe underestimated, the prevalence in rheumatoid arthritis seems higher. Thus the recent studies, using modern processes such as high resolution computed tomography of the lungs, assess this association to about 25%. Nevertheless, the methodology of these studies is open to criticism, so the high frequency must be qualified. The pathogenic and aetiological factors remain unknown, and miscellaneous hypotheses, especially immunological, have been suggested. The relationship between both affections can not be asserted, but the association is unlikely to be fortuitous.
11396097 Pathogenesis of rheumatoid arthritis: the role of synoviocytes. 2001 May Considering the characteristics of RA synovial tissues such as marked proliferation and invasion to adjacent tissues, comparisons with transformed or neoplastic tissue are natural. RA synovial tissues or cells are not truly malignant, but they have many features of transformation, denoted as "partial transformation" in this article. These features include anchorage-independent growth, loss of contact inhibition, oncogene activation, monoclonal or oligoclonal expansion, detectable telomerase activity, and somatic gene mutations. Although it is not possible to conclude whether most of these cells are permanently changed in association with some genetic alterations or are passively changed by virtue of environmental factors (i.e., cytokine-mediated imprinting), the presence of p53 mutations in RA synovial tissues is especially persuasive. A number of transcription factors play a critical role in the activation, differentiation, and proliferation of RA synovial cells. In particular, the roles of AP-1, MAPKs, and NF-kappa B have been investigated carefully because of their ability to regulate numerous inflammation-related genes. These transcription factors also control expression and activation of matrix-degrading enzymes, including MMPs, aggrecanase, and cysteine proteases, which are the primary enzymes responsible for joint destruction. Elucidation of gene mutations and detailed signal transduction pathways that are specific to RA as well as mechanisms of action of matrix-degrading enzymes may lead to development of a novel therapy for RA. Careful mapping of cytokine networks a decade ago led to groundbreaking advances in therapy. Similarly, methodical evaluation and prioritization of intracellular targets might provide the basis for therapeutic interventions.
9494987 The rheumatoid shoulder. 1998 Feb Rheumatoid arthritis of the glenohumeral joint can produce significant pain and disability that interferes with the ability to perform even the basic activities of daily living. In this article the authors discuss the epidemiologic aspects of rheumatoid arthritis, the pathologic condition as it affects the shoulder complex (consisting of the glenohumeral, acromioclavicular, and sternoclavicular joints), the differential diagnosis, clinical and radiographic manifestations, and treatment approaches designed to maintain or regain function.
10689543 Recent advances in the treatment of rheumatoid arthritis. 1999 Rheumatoid arthritis (RA) affects about 0.5% to 1% of the population worldwide. Because there is no cure for this disease, the goal of therapy is to control the underlying inflammatory process and maintain or improve function. This article reviews 4 new treatments for patients with RA: leflunomide, etanercept, infliximab, and the protein A immunoadsorption column with plasmapheresis therapy.
11812022 Signal transduction in rheumatoid arthritis. 2001 Dec Extracellular signals are transduced intracellularly by multiple pathways, resulting in alterations in the transcription and translation of specific proteins. The end result of some of these signalling pathways is the production of proteins, including cytokines and matrix metalloproteinases, that are implicated in the pathogenesis of rheumatoid arthritis. This chapter includes a discussion of these signal transduction pathways, including tumour necrosis factor receptor signalling, interleukin-1, -4, and -6 receptor signalling, stress- and mitogen-activated protein kinase pathways, CD14 and Toll-like receptor signalling, and T cell signal transduction. The known effects of currently available rheumatoid arthritis (RA) therapeutics on these signalling pathways are also reviewed. In addition, potential future targets for therapeutic intervention in RA are discussed.
9481233 Assessing cost-effectiveness analyses in rheumatoid arthritis and osteoarthritis. 1997 Dec Economic considerations are now a source of great concern to clinicians and policy analysts. Many cost-effectiveness analyses have been published in the area of arthritis, most with substantial methodologic deficiencies. The goal of this article is to outline a method for evaluating cost-effectiveness assessment within the field of rheumatology. We do so by critically evaluating 6 cost-effectiveness analyses--2 in rheumatoid arthritis and 4 in osteoarthritis--as a basis for appraising the literature and developing future studies.
11396096 Pathogenesis of rheumatoid arthritis. Role of B lymphocytes. 2001 May Despite many years of investigation, there remain many unanswered fundamental questions on the role of B cells in RA. Why is RF found in the sera of 80% of patients with RA and often in other chronic inflammatory diseases? What signals lead B lymphocytes to migrate into the subsynovial lining of joints? Does receptor revision in synovium play a role in the generation of autoantibodies in RA? What is the relative contribution of B-cell inhibition on the salutary effect of medications for RA? Can targeting autoreactive B cells, in conjunction with other therapies, provide therapeutic benefit in RA? We are hopeful that through continued basic, clinical, and translational research, these questions can be answered.
11140470 The role of T cells in rheumatoid arthritis. 2000 In rheumatoid arthritis (RA), T cells infiltrate into the synovial membrane where they initiate and maintain activation of macrophages and synovial fibroblasts, transforming them into tissue-destructive effector cells. The diversity of the disease process and the formation of complex lymphoid microstructures indicate that multiple T cell activation pathways are involved. This model is supported by the association of distinct disease patterns with different variants and combinations of HLA class II molecules. T cell pathology in RA, however, is not limited to the joint. Affected patients have major abnormalities in the T cell pool, with a marked contraction in T cell receptor diversity and an outgrowth of large clonal populations. Clonally expanded CD4+ T cells lose expression of the CD28 molecule and gain expression of perforin and granzyme. Consequently, the functional profile of expanded CD4(+)CD28null T cells is fundamentally changed and is shifted towards tissue-injurious capabilities. CD4(+)CD28null T cells are particularly important in patients with extra-articular manifestations of RA, where they may have a direct role in vascular injury. Understanding the mechanisms underlying the loss of T cell diversity and the emergence of pro-inflammatory CD4(+)CD28null T cell clonotypes may have implications for other autoimmune syndromes.
10589355 New approaches to imaging of early rheumatoid arthritis. 1999 Nov Conventional radiology (CR) is a major tool for the diagnosis and assessment of early arthritis. However, CR does not image the primary pathology of rheumatoid arthritis (RA), i.e. the synovium, and is insensitive for radiological erosions. New techniques, particularly magnetic resonance imaging (MRI) and ultrasonography (US) have shown their potential to improve on the sensitivity of CR. This article reviews the current status of this approach in early disease.
11782106 The schizophrenia-rheumatoid arthritis connection: infectious, immune, or both? 2001 Dec Schizophrenia and rheumatoid arthritis share an impressive number of similarities. Both are chronic, relapsing diseases of unknown etiology. Both became prominent in the early 19th century and have prevalences of approximately 1% in North America and Europe. Both run in families, have pairwise concordance rates of approximately 30% among monozygotic twins, and are more common among individuals born in urban areas. For both diseases, studies have reported greater exposure to cats in childhood than in controls. Both diseases have been associated with similar class II HLA antigens. Both have also been suspected of having infectious etiology, with similar agents--retroviruses, herpesviruses including EBV, and Toxoplasma gondii--having been associated in some cases. Since there is also a well-documented inverse correlation between these two diseases, it is possible that they share a common infectious and/or immune etiology and that once a person gets one of the diseases then they are relatively immune to the other.
11469381 Biologic agents in the treatment of rheumatoid arthritis. 2000 Nov Advances in the understanding of the pathogenesis of rheumatoid arthritis (RA) as well as improved biotechnology has enabled selective targeting of the pathogenic elements of disease. Targeting cell recruitment through adhesion molecules has been shown to be successful in pre-clinical murine models. Results of studies of an anti-ICAM-1 monoclonal antibody and anti-sense oligonucleotides have been encouraging. An alternate approach to inhibiting recruitment has been the targeting of chemoattractant molecules ie. chemokines. Important advances have been made in cytokine directed therapy targeting TNFalpha and IL-1. TNF antagonists (anti-TNF monoclonal antibody/soluble TNF receptor Fc fusion protein) have resulted in rapid and substantial improvement in signs and symptoms of disease as well as disease modification, shown by slowing of radiological progression. IL-1 receptor antagonist protein appears to have a significant effect on radiological progression despite a modest effect on symptoms and signs. Studies using anti-inflammatory cytokines such as IL-10 are in progress. A more recent therapeutic approach has been to target T-cell activation by interfering with co-stimulatory complexes such as CD40L/CD40 and CD28/CD80 and CD86. Both pre-clinical and preliminary clinical studies in human subjects support the concept. Another approach involving T-cell receptor peptide vaccination with VB peptides over-utilized in RA synovium has shown to be beneficial. Targeting the cytokines driving T-cells in the RA synovium ie. IL-12 & IL-15 has also proven beneficial in animal studies. Recent attention has also been directed toward the invading synovial fibroblast using Fas-FasL mediated apoptosis. Pre-clinical studies in which angiogenesis and osteoclast activation are targeted have been encouraging. In conclusion, the proof of principle has been established that selective targeting of pathogenic elements of disease results in substantial improvement in signs and symptoms as well as disease progression. Improved efficacy is expected with more aggressive targeting of the pathogenic elements.
9494983 Perioperative medical considerations in patients with rheumatoid arthritis. 1998 Feb Patients who suffer from chronic rheumatologic diseases, such as rheumatoid arthritis, frequently require orthopedic surgical intervention during the course of their illness. This article provides the reader with an overview of approaches to postoperative risk stratification. Reviewed are the basic concepts that underlie perioperative medical management, including such issues as the preoperative medical assessment, the currently employed anesthetic techniques, and approaches to postoperative analgesia. The impact of comorbid conditions on surgical outcome is discussed as are specific clinical problems that have particular relevance to the patient with rheumatoid arthritis.
9062951 Compliance in rheumatoid arthritis and the role of formal patient education. 1997 Feb OBJECTIVE: This study was performed to determine the compliance with the basic treatments for rheumatoid arthritis (RA; medication, physical therapy, and ergonomic measures), to study psychological factors that influence compliance in light of the social learning theory, to learn whether patient education positively influences compliance and health, and to find an approach to patient education that improves compliance. METHODS: A MEDLINE search of the English language literature was performed. RESULTS: Few studies have dealt with compliance in RA patients; levels of adherence are generally low. According to the social learning theory, human function involves a continuous interaction between behavior, personal factors, and external environment. Self-efficacy is a personal factor that refers to the belief in one's capabilities and opportunities for being compliant with treatment advice. Patient education may improve ergonomic performance and compliance with physical exercise programs. CONCLUSIONS: Compliance with medication was infrequently studied. Whether improved compliance leads to better health status could not be determined. Compliance with RA treatments are generally low. Systematic study of the effect of patient education on treatment and health is warranted. Self-efficacy enhancing techniques in patient education may improve compliance.
9662755 Omega-3 fatty acids in rheumatoid arthritis: an overview. 1998 Jun OBJECTIVES: To review background, pharmacological properties, mechanisms of action, and published clinical experience using omega-3 fatty acids in rheumatoid arthritis. MATERIALS AND METHODS: English language publications were identified through a computerized search (using MEDLINE) between 1979 and 1995 using the terms "omega-3 fatty acids" and "fish oil". In addition, manual search and cross references were used to obtain published articles on the subject. Papers showing evidence of pharmacological properties and mechanisms of action were analyzed. For therapeutic efficacy, only randomized clinical trials are presented in this article. All papers were reviewed by a board certified rheumatologist with training in research methodology and critical appraisal skills. He was aware of study objectives. RESULTS: Main results are summarized in the text and presented in tables. Mean change from baseline is presented only for patients treated with omega-3 fatty acids. Omega-3 fatty acids are superior with respect to placebo in improving some outcome measures, and decrease the long-term requirements for nonsteroidal antiinflammatory drugs. Some of these effects are statistically significant, but their clinical significance remain to be established. CONCLUSIONS: Treatment with omega-3 fatty acids has been associated with improvement in some outcome measures in rheumatoid arthritis. Studies are needed to determine if they might represent an alternative to nonsteroidal antiinflammatory drugs in certain circumstances.
11202484 Potential pathogenesis and clinical aspects of pulmonary fibrosis associated with rheumato 2001 Jan Pulmonary fibrosis is an extra-articular disorder that can occur in association with rheumatoid arthritis. The differential diagnosis of this disorder is similar to that of idiopathic pulmonary fibrosis, but specific entities such as atypical pulmonary infections and drug-induced interstitial lung disease must be considered as causes of pulmonary fibrosis in patients with rheumatoid arthritis. Although the cause of lung fibrosis in persons with rheumatoid arthritis is unknown, factors that can potentially contribute to the pathogenesis of this pulmonary disease include genetic susceptibility, development of an altered immunologic response, and/or aberrant host repair processes. The clinical course of patients with pulmonary fibrosis and rheumatoid arthritis is heterogeneous but is generally insidious, chronic, and progressive. These patients respond unpredictably to available empiric therapeutic agents and, overall, their prognosis is poor; limited data suggests that the median survival time can be less than 4 years.
9455964 The prognosis of rheumatoid arthritis: assessment of disease activity and disease severity 1997 Dec 29 The prognosis of rheumatoid arthritis is best described separately for mortality, work disability, costs, functional disability, total joint arthroplasty, radiographic abnormality, and psychosocial factors. The most important determinants of prognoses are the severity and persistence of disease activity. Methods for disease activity assessment have been developed for use in clinical trials, but these are often not suitable for use in clinical practice because of time constraints, costs, and special training required. However, clinicians can measure disease activity relatively simply according to joint counts, acute-phase reactants, and patient self-report tests. Nomograms, based on percentile ranking of disease activity variables, are simple tools that can be used in the clinic to estimate disease activity and change in clinical status.
10556255 Stress system response and rheumatoid arthritis: a multilevel approach. 1999 Nov A growing body of research indicates that the stress system, and its interactions with the immune system, play a pivotal role in the aetiology and progression of rheumatoid arthritis (RA). The stress system has multiple levels and comprises physiological, psychological and environmental components. However, most investigations in RA that involve the stress system tend to focus on the interrelationships between neuroendocrine and immune function, and related disease activity, with little regard for the role of other aspects of stress system activation, including psychological variables. This is despite the fact that psychological stressors, and related psychological variables, are known to influence RA disease activity. This article aims to explore the multiple levels of stress system activation and how they may ultimately influence disease-related outcomes in RA. Some measurement issues of psychological stress will also be examined.